Most Americans want to die at home and receiving hospice care is a significant predictor that such a preference is realized. Nevertheless, even for hospice patients, death in an inpatient facility is increasingly common. This trend, with associated transitions in settings of care for patients, has cost and quality implications for a growing population of older adults who will need care at the end of life in an already expensive and overburdened health care system. The applicant seeks to understand and describe the beliefs and practices related to transitions within hospice care settings from the perspective of patients, family caregivers, and hospice interdisciplinary teams. The proposed ethnography will illuminate contextualized themes and lead to future research in quality and outcomes in end-of-life care. Ultimately, the applicant aims to provide direction in health policy for cost-effective, quality end-of-life care for the growing population of older adults. The proposed study will specifically address the location of care and death for older adults enrolled in formal hospice care. The training plan and proposed study are aligned well with the scope and mission of NINR, which is the lead institute on end-of-life science and palliative care. PUBLIC HEALTH RELEVANCE: With the rapid proliferation of hospice inpatient care, older adults who use hospice services and their families increasingly negotiate where to receive care. Understanding the complexity of settings of care in hospice from the perspective of hospice patients, family caregivers, and hospice interdisciplinary teams will inform future interventions, measurement of quality outcomes and policy. This has the potential to impact public health by improving the continuity of care for older adults living and dying with terminal illness.